If you feel like the day doesn’t hold enough hours for you to get your work done, you’re right: (EHRs).
Investigators followed 141 academic PCPs between May 2019 and March 2023 and found they spent considerably more time engaging in EHR tasks during the final year of the study than in the prepandemic period. EHR time increased by over 8% on days with scheduled appointments and almost 20% on days without scheduled appointments.
“Physicians spend an unsustainable amount of time on EHR-based work, and that amount has increased steadily from 2019 to 2023,” Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association (AMA) and the senior author of the study, told this news organization. “It is imperative for healthcare systems to develop strategies to change the overall EHR workload trajectory to minimize PCPs’ occupational stress, including improved workflows, where the work is more appropriately distributed amongst the team.”
The study was published online on January 22, 2024, in the Annals of Family Medicine.
‘Pajama Time’
Dr. Sinsky said the motivation for conducting the current study was that PCPs have reported an increase in their workload, especially EHR tasks outside of work (“pajama time”) since the onset of the pandemic.
The research followed up on a 2017 analysis from the same group and other findings showing an increase in the time physicians spend in EHR tasks and the number of Inbox messages they receive from patients seeking medical advice increased during the months following the start of the pandemic.
“As a busy practicing PCP with a large panel of patients, my sense was that the workload was increasing even more, which is what our study confirmed,” said Brian G. Arndt, MD, of the Department of Family Medicine and Community Heath at the University of Wisconsin School of Medicine and Public Health, in Madison, Wisconsin, who led the new study.
The researchers analyzed EHR usage of 141 academic PCPs practicing family medicine, internal medicine, and general pediatrics, two thirds (66.7%) of whom were female. They compared the amount of time spent on EHR tasks during four timespans:
- May 2019 to February 2020
- June 2020 to March 2021
- May 2021 to March 2022
- April 2022 to March 2023
Each PCP’s time and Inbox message volume were calculated and then normalized over 8 hours of scheduled clinic appointments.
Increased Time, Increased Burnout
The study found evidence PCPs have reduced their clinical hours in response to their growing digital workload.
“We have a serious shortage of primary care physicians,” Dr. Sinsky said. “When PCPs cut back their clinical [work] as a coping mechanism for an unmanageable workload, this further exacerbates the primary care shortage, reducing access to care for patients.”
The researchers found increases from the first prepandemic period to the final period of their study in average time that PCPs spent at the EHR per 8 hours of scheduled clinic appointments (Table).
PCPs were inundated with several types of EHR-related responsibilities, including more medical advice requests (+55.5%) and more prescription messages (+19.5%) per 8 hours of scheduled clinic appointments. On the other hand, they had slightly fewer patient calls (−10.5%) and messages concerning test results (−2.7%).
A recent study of 307 PCPs across 31 primary care practices paralleled these findings. It found that physicians spent 36.2 minutes on the EHR per visit (interquartile range, 28.9-45.7 minutes). Included were 6.2 minutes of “pajama time” per visit and 7.8 minutes on the EHR per visit.
The amount of EHR time exceeded the amount of time allotted to a primary care visit (30 minutes). The authors commented that the EHR time burden “and the burnout associated with this burden represent a serious threat to the primary care physician workforce.”
“As more health systems across the country transition from fee-for-service to value-based payment arrangements, they need to balance the time PCPs and their care teams need for face-to-face care — in-person or video visits — with the increasing asynchronous care patients are seeking from us through the portal, for example, MyChart,” Dr. Arndt said.
Sinsky noted that when patients receive care from a PCP, quality is higher and costs are lower. “When access to primary care is further limited by virtue of physicians being overwhelmed by administrative work implemented via the EHR, so that they are reducing their hours, then we can expect negative consequences for patient care and costs of care.”